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Do QN, Herrera CL, Rosenthal EA, Xi Y, Uddin N, Lewis MA, Fei B, Spong CY, Twickler DM. Magnetic resonance imaging improves diagnosis of placenta accreta spectrum requiring hysterectomy compared to ultrasound. Am J Obstet Gynecol MFM 2024; 6:101280. [PMID: 38216054 PMCID: PMC11070455 DOI: 10.1016/j.ajogmf.2024.101280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Magnetic resonance imaging has been used increasingly as an adjunct for ultrasound imaging for placenta accreta spectrum assessment and preoperative surgical planning, but its value has not been established yet. The ultrasound-based placenta accreta index is a well-validated standardized approach for placenta accreta spectrum evaluation. Placenta accreta spectrum-magnetic resonance imaging markers have been outlined in a joint guideline from the Society of Abdominal Radiology and the European Society of Urogenital Radiology. OBJECTIVE This study aimed to compare placenta accreta spectrum-magnetic resonance imaging parameters with the ultrasound-based placenta accreta index in pregnancies at high risk for placenta accreta spectrum and to assess the additional diagnostic value of magnetic resonance imaging for placenta accreta spectrum that requires a cesarean hysterectomy. STUDY DESIGN This was a single-center, retrospective study of pregnant patients who underwent magnetic resonance imaging, in addition to ultrasonography, because of suspected placenta accreta spectrum. The ultrasound-based placenta accreta index and placenta accreta spectrum-magnetic resonance imaging parameters were obtained. Student's t test and Fisher's exact test were used to compare the groups in terms of the primary outcome (hysterectomy vs no hysterectomy). The diagnostic performance of magnetic resonance imaging and the ultrasound-based placenta accreta index was assessed using multivariable logistic regressions, receiver operating characteristics curves, the DeLong test, McNemar test, and the relative predictive value test. RESULTS A total of 82 patients were included in the study, 41 of whom required a hysterectomy. All patients who underwent a hysterectomy met the International Federation of Gynecology and Obstetrics clinical evidence of placenta accreta spectrum at the time of delivery. Multiple parameters of the ultrasound-based placenta accreta index and placenta accreta spectrum-magnetic resonance imaging were able to predict hysterectomy, and the parameter of greatest dimension of invasion by magnetic resonance imaging was the best quantitative predictor. At 96% sensitivity for hysterectomy, the cutoff values were 3.5 for the ultrasound-based placenta accreta index and 2.5 cm for the greatest dimension of invasion by magnetic resonance imaging. Using this sensitivity, the parameter of greatest dimension of invasion measured by magnetic resonance imaging had higher specificity (P=.0016) and a higher positive predictive value (P=.0018) than the ultrasound-based placenta accreta index, indicating an improved diagnostic threshold. CONCLUSION In a suspected high-risk group for placenta accreta spectrum, magnetic resonance imaging identified more patients who will not need a hysterectomy than when using the ultrasound-based placenta accrete index only. Magnetic resonance imaging has the potential to aid patient counseling, surgical planning, and delivery timing, including preterm delivery decisions for patients with placenta accreta spectrum requiring hysterectomy.
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Affiliation(s)
- Quyen N Do
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler)
| | - Christina L Herrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler); Parkland Health and Hospital System, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler)
| | - Elise A Rosenthal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler); Parkland Health and Hospital System, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler)
| | - Yin Xi
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler)
| | - Naseem Uddin
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX (Dr Uddin)
| | - Matthew A Lewis
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler)
| | - Baowei Fei
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler); Department of Bioengineering, The University of Texas at Dallas, Richardson, TX (Dr Fei); Center for Imaging and Surgical Innovation, The University of Texas at Dallas, TX (Dr Fei)
| | - Catherine Y Spong
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler); Parkland Health and Hospital System, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler)
| | - Diane M Twickler
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler); Parkland Health and Hospital System, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler).
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2
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Khan A, Do QN, Xi Y, Spong CY, Happe SK, Dashe JS, Twickler DM. Inter-reader agreement of multi-variable MR evaluation of Placenta Accreta Spectrum (PAS) and association with cesarean hysterectomy. Placenta 2022; 126:196-201. [PMID: 35868245 PMCID: PMC10392140 DOI: 10.1016/j.placenta.2022.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/05/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Ambereen Khan
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Quyen N Do
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA; Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA; Parkland Health and Hospital System, Dallas, TX, USA
| | - Sarah K Happe
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Jodi S Dashe
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Diane M Twickler
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA; Department of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
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3
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Hong S, Le Y, Lio KU, Zhang T, Zhang Y, Zhang N. Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: a systematic review and meta-analysis. Insights Imaging 2022; 13:50. [PMID: 35316430 PMCID: PMC8940971 DOI: 10.1186/s13244-022-01192-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Accurate prenatal diagnosis of placenta accrete spectrum disorder (PAS) remains a challenge, and the reported diagnostic value of ultrasonography (US) and magnetic resonance imaging (MRI) varies widely. This study aims to systematically evaluate the diagnostic accuracy of US as compared with MRI in the detection of PAS within the identical patient population. METHODS Medline, EMBASE, Google scholar and Cochrane library were searched. Pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic (SROC) curve were calculated. Subgroup analysis was also performed to elucidate the heterogeneity of results. RESULTS A total of 18 articles comprising 861 pregnancies were included in the study. The overall diagnostic accuracy of US for identification of PAS was as follows: sensitivity [0.90 (0.86-0.93)], specificity [0.83 (0.79-0.86)], DOR [39.5 (19.6-79.7)]. The overall diagnostic accuracy of MRI for identification of PAS was as follows: sensitivity [0.89 (0.85-0.92)], specificity [0.87 (0.83-0.89)], DOR [37.4 (17.0-82.3)]. The pooled sensitivity (p = 0.808) and specificity (p = 0.413) between US and MRI are not significantly different. SROC analysis revealed that there was no statistical difference (p = 0.552) in US and MRI for the overall predictive accuracy of PAS. Furthermore, in the subgroup analysis of between retrospective and prospective studies, between earlier and most recent studies, there was no statistical difference (p > 0.05) in diagnostic accuracy of US and MRI for the detection of PAS. CONCLUSIONS Both ultrasonography (US) and magnetic resonance imaging (MRI) showed comparable accuracy in the prenatal diagnosis of placenta accrete spectrum disorder (PAS). Routine employment of MRI with relatively high expense in the prenatal identification of PAS should not be recommended.
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Affiliation(s)
- Shibin Hong
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China.,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Yiping Le
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Ka U Lio
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine at Temple University, 3401 N Broad St, Philadelphia, PA, 19140, USA
| | - Ting Zhang
- Department of Obstetrics and Gynecology, Hainan Women and Children's Medical Center, Changbin Road, Haikou City, 570312, Hainan Province, China
| | - Yu Zhang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China. .,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
| | - Ning Zhang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China. .,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
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Fiocchi F, Monelli F, Besutti G, Casari F, Petrella E, Pecchi A, Caporali C, Bertucci E, Busani S, Botticelli L, Facchinetti F, Torricelli P. MRI of placenta accreta: diagnostic accuracy and impact of interventional radiology on foetal-maternal delivery outcomes in high-risk women. Br J Radiol 2020; 93:20200267. [PMID: 32706979 DOI: 10.1259/bjr.20200267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI. METHODS 26 patients (mean age 36.24 y/o,SD 6.16) with clinical risk-factors and echographic suspicion of IP underwent 1.5 T-MRI. Two readers reviewed images. Gold-standard was histology in hysterectomised patients and obstetric evaluation at delivery for patients with preserved uterus. Accuracy and reproducibility of MRI findings were calculated. RESULTS Incidence of IP was 50% (13/26) and of PP was 11.54% (3/26). MRI showed 100% sensitivity (95% CI = 75.3-100%) and 92.3% specificity (95% CI = 64.0-100%) in the diagnosis of IP. Gold-standard was histology in 10 cases and obstetric evaluation in 16. MRI findings with higher sensitivity were placental heterogeneity, uterine bulging and black intraplacental bands. Uterine scarring, placental heterogeneity, myometrial interruption and tenting of the bladder showed better specificity. MRI inter-rater agreement with Cohen's K was 1. 11 patients among 14 with MRI diagnosis of IP received IR assistance with positive impact on delivery outcomes in terms of blood loss, red cells count, intense care unit length of stay, days of hospitalisation and risk of being transfused. CONCLUSION MRI is an accurate and reproducible technique in prenatal diagnosis of IP. MRI helps planning a safe and appropriate delivery eventually assisted by IR, which positively affects foetal and maternal outcomes. ADVANCES IN KNOWLEDGE The adoption of MRI evaluation in patients with high risk of invasive placentation allows a more accurate diagnosis in terms of both presence of the disease and its extension to or through or even beyond the myometrium. This led to a better dedicated delivery management with eventual adoption of interventional radiology with a global positive effect on foetal and maternal outcomes.
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Affiliation(s)
- Federica Fiocchi
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Filippo Monelli
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Giulia Besutti
- University of Modena and Reggio Emilia, Clinical and Experimental Medicine PhD program, Modena, Italy
| | - Federico Casari
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Elisabetta Petrella
- Department of Medical and SurgicaSciences for Mothers, Children and Adults, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Annarita Pecchi
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Cristian Caporali
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Emma Bertucci
- Department of Medical and SurgicaSciences for Mothers, Children and Adults, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Stefano Busani
- Departement of intensive care medicine, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Laura Botticelli
- Departement of Pathology, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and SurgicaSciences for Mothers, Children and Adults, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Pietro Torricelli
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
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5
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Yu FNY, Leung KY. Antenatal diagnosis of placenta accreta spectrum (PAS) disorders. Best Pract Res Clin Obstet Gynaecol 2020; 72:13-24. [PMID: 32747328 DOI: 10.1016/j.bpobgyn.2020.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
Antenatal diagnosis of placenta accreta spectrum (PAS) disorders allows planned management by a multidisciplinary team in a tertiary center, and thus can reduce hemorrhagic morbidity, compared with intrapartum diagnosis. Previous Cesarean section and placenta previa are the two most common risk factors. Prenatal ultrasound is a promising diagnostic tool for PAS in the second or third trimester. Recent evidence shows sonographic markers of PAS can be present in the first trimester. Prenatal ultrasound may help predict the depth and topography of placental invasion which are the major determinants of maternal morbidity. The presence of increased vascularity in the inferior part of the lower uterine segment and the parametrial region is associated with a more severe disorder according to a newly proposed staging system. In this chapter, we will discuss how to improve the prediction of PAS, the depth, and topography of placental invasion.
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Affiliation(s)
- Florrie N Y Yu
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K Y Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China; Gleneagles Hong Kong, Hong Kong SAR, China.
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6
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Placenta Accreta Spectrum: Correlation of MRI Parameters With Pathologic and Surgical Outcomes of High-Risk Pregnancies. AJR Am J Roentgenol 2020; 214:1417-1423. [DOI: 10.2214/ajr.19.21705] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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7
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Poder L, Weinstein S, Maturen KE, Feldstein VA, Mackenzie DC, Oliver ER, Shipp TD, Strachowski LM, Sussman BL, Wang EY, Weber TM, Whitcomb BP, Glanc P. ACR Appropriateness Criteria® Placenta Accreta Spectrum Disorder. J Am Coll Radiol 2020; 17:S207-S214. [PMID: 32370965 DOI: 10.1016/j.jacr.2020.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
Placenta accreta spectrum disorder (PASD) is the current terminology recommended by the International Federation of Obstetrics and Gynecology (FIGO) and should replace terms such as abnormally adherent/invasive placenta or morbidly adherent placenta. PASD refers to a variety of potential clinical complications, which may result from abnormal placental implantation. More specifically, placenta accreta refers to a defect in the decidua basalis where the chorionic villi adhere directly to the myometrium with trophoblastic invasion. Accurate antenatal diagnosis is needed to plan for an appropriate delivery strategy at an experienced center in order to reduce maternal and potential fetal morbidity and mortality. Obtaining radiologic and clinical data when PASD is first suspected can play a significant role in formulating an appropriate delivery strategy. Depending on the clinical risk factors and initial imaging findings, transabdominal ultrasound of the pregnant uterus with duplex Doppler and transvaginal ultrasound as needed are the most appropriate imaging procedures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Liina Poder
- University of California San Francisco, San Francisco, California.
| | - Stefanie Weinstein
- Research Author, University of California San Francisco, San Francisco, California
| | | | | | - David C Mackenzie
- Maine Medical Center, Portland, Maine; American College of Emergency Physicians
| | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American College of Obstetricians and Gynecologists
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | - Bradford P Whitcomb
- University of Connecticut, Farmington, Connecticut; Society of Gynecologic Oncology
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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8
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Jansen CHJR, Kastelein AW, Kleinrouweler CE, Van Leeuwen E, De Jong KH, Pajkrt E, Van Noorden CJF. Development of placental abnormalities in location and anatomy. Acta Obstet Gynecol Scand 2020; 99:983-993. [PMID: 32108320 PMCID: PMC7496588 DOI: 10.1111/aogs.13834] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/13/2020] [Accepted: 02/23/2020] [Indexed: 12/12/2022]
Abstract
Low‐lying placentas, placenta previa and abnormally invasive placentas are the most frequently occurring placental abnormalities in location and anatomy. These conditions can have serious consequences for mother and fetus mainly due to excessive blood loss before, during or after delivery. The incidence of such abnormalities is increasing, but treatment options and preventive strategies are limited. Therefore, it is crucial to understand the etiology of placental abnormalities in location and anatomy. Placental formation already starts at implantation and therefore disorders during implantation may cause these abnormalities. Understanding of the normal placental structure and development is essential to comprehend the etiology of placental abnormalities in location and anatomy, to diagnose the affected women and to guide future research for treatment and preventive strategies. We reviewed the literature on the structure and development of the normal placenta and the placental development resulting in low‐lying placentas, placenta previa and abnormally invasive placentas.
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Affiliation(s)
- Charlotte H J R Jansen
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Arnoud W Kastelein
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C Emily Kleinrouweler
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Elisabeth Van Leeuwen
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kees H De Jong
- Department of Medical Biology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Cornelis J F Van Noorden
- Department of Medical Biology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Genetic Toxicology and Tumor Biology, National Institute of Biology, Ljubljana, Slovenia
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9
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Reliability of Magnetic Resonance Imaging in diagnosis and assessment the depth of invasion of placental accreta in high risk gravid women. Clin Imaging 2019; 58:5-11. [DOI: 10.1016/j.clinimag.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/20/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
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10
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Do QN, Lewis MA, Xi Y, Madhuranthakam AJ, Happe SK, Dashe JS, Lenkinski RE, Khan A, Twickler DM. MRI of the Placenta Accreta Spectrum (PAS) Disorder: Radiomics Analysis Correlates With Surgical and Pathological Outcome. J Magn Reson Imaging 2019; 51:936-946. [DOI: 10.1002/jmri.26883] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Quyen N. Do
- The Department of RadiologyUT Southwestern Medical Center Dallas Texas USA
| | - Matthew A. Lewis
- The Department of RadiologyUT Southwestern Medical Center Dallas Texas USA
| | - Yin Xi
- The Department of RadiologyUT Southwestern Medical Center Dallas Texas USA
- Department of Clinical ScienceUT Southwestern Medical Center Dallas Texas USA
| | - Ananth J. Madhuranthakam
- The Department of RadiologyUT Southwestern Medical Center Dallas Texas USA
- Advanced Imaging Research CenterUT Southwestern Medical Center Dallas Texas USA
| | - Sarah K. Happe
- Obstetrics & GynecologyUT Southwestern Medical Center Dallas Texas USA
| | - Jodi S. Dashe
- Obstetrics & GynecologyUT Southwestern Medical Center Dallas Texas USA
| | - Robert E. Lenkinski
- The Department of RadiologyUT Southwestern Medical Center Dallas Texas USA
- Advanced Imaging Research CenterUT Southwestern Medical Center Dallas Texas USA
| | - Ambereen Khan
- The Department of RadiologyUT Southwestern Medical Center Dallas Texas USA
| | - Diane M. Twickler
- The Department of RadiologyUT Southwestern Medical Center Dallas Texas USA
- Obstetrics & GynecologyUT Southwestern Medical Center Dallas Texas USA
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11
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Jha P, Rabban J, Chen LM, Goldstein RB, Weinstein S, Morgan TA, Shum D, Hills N, Ohliger MA, Poder L. Placenta accreta spectrum: value of placental bulge as a sign of myometrial invasion on MR imaging. Abdom Radiol (NY) 2019; 44:2572-2581. [PMID: 30968183 DOI: 10.1007/s00261-019-02008-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate correlation of "placental bulge sign" with myometrial invasion in placenta accreta spectrum (PAS) disorders. Placental bulge is defined as deviation of external uterine contour from expected plane caused by abnormal outward bulge of placental tissue. MATERIALS AND METHODS In this IRB-approved, retrospective study, all patients undergoing MRI for PAS disorders between March 2014 and 2018 were included. Patients who delivered elsewhere were excluded. Imaging was reviewed by 2 independent readers. Surgical pathology from Cesarean hysterectomy or pathology of the delivered placenta was used as reference standard. Fisher's exact and kappa tests were used for statistical analysis. RESULTS Sixty-one patients underwent MRI for PAS disorders. Two excluded patients delivered elsewhere. Placental bulge was present in 32 of 34 cases with myometrial invasion [True positive 32/34 = 94% (95% CI 0.80-0.99)]. Placental bulge was absent in 24 of 25 cases of normal placenta or placenta accreta without myometrial invasion [True negative = 24/25, 96% (95% CI 80-99.8%)]. Positive and negative predictive values were 97% and 96%, respectively. Placental bulge in conjunction with other findings of PAS disorder was 100% indicative of myometrial invasion (p < 0.01). Kappa value of 0.87 signified excellent inter-reader concordance. In 1 false positive, placenta itself was normal but the bulge was present. Surgical pathology revealed markedly thinned, fibrotic myometrium without accreta. One false-negative case was imaged at 16 weeks and may have been imaged too early. CONCLUSIONS Placental bulge in conjunction with other findings of invasive placenta is 100% predictive of myometrial invasion. Using the bulge alone without other signs can lead to false-positive results.
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Affiliation(s)
- Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA, 94131, USA.
| | - Joseph Rabban
- Department of Pathology, University of California San Francisco, San Francisco, USA
| | - Lee-May Chen
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, USA
| | - Ruth B Goldstein
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA, 94131, USA
| | - Stefanie Weinstein
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA, 94131, USA
| | - Tara A Morgan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA, 94131, USA
| | - Dorothy Shum
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA, 94131, USA
| | - Nancy Hills
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA, 94131, USA
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA, 94131, USA
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12
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Abstract
The term "morbidly adherent placenta" has recently been introduced to describe the spectrum of disorders including placenta accreta, increta and percreta. Due to excessive invasion of the placenta into the uterus there is associated significant maternal morbidity and mortality. Most significant risk factors for morbidly adherent placenta include history of prior cesarean delivery as well as placenta previa in the current pregnancy. Ultrasound remains the gold standard for antenatal diagnosis, however, in recent years MRI has assisted in identifying complex parametrial involvement. Optimizing maternal and neonatal outcomes involves early prenatal diagnosis, a multi-disciplinary team-based approach, and referral to an experienced center.
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Affiliation(s)
- Whitney Booker
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, United States.
| | - Leslie Moroz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, United States
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Jauniaux E, Bhide A, Kennedy A, Woodward P, Hubinont C, Collins S. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. Int J Gynaecol Obstet 2018; 140:274-280. [PMID: 29405319 DOI: 10.1002/ijgo.12408] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Amar Bhide
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, St George's Hospital, London, UK
| | - Anne Kennedy
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Paula Woodward
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Corrine Hubinont
- Department of Obstetrics, Saint Luc University Hospital, University of Louvain, Brussels, Belgium
| | - Sally Collins
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
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Prola-Netto J, Woods M, Roberts VHJ, Sullivan EL, Miller CA, Frias AE, Oh KY. Gadolinium Chelate Safety in Pregnancy: Barely Detectable Gadolinium Levels in the Juvenile Nonhuman Primate after in Utero Exposure. Radiology 2017; 286:122-128. [PMID: 28873045 DOI: 10.1148/radiol.2017162534] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To determine whether gadolinium remains in juvenile nonhuman primate tissue after maternal exposure to intravenous gadoteridol during pregnancy. Materials and Methods Gravid rhesus macaques and their offspring (n = 10) were maintained, as approved by the institutional animal care and utilization committee. They were prospectively studied as part of a pre-existing ongoing research protocol to evaluate the effects of maternal malnutrition on placental and fetal development. On gestational days 85 and 135, they underwent placental magnetic resonance imaging after intravenous gadoteridol administration. Amniocentesis was performed on day 135 prior to administration of the second dose of gadoteridol. After delivery, the offspring were followed for 7 months. Tissue samples from eight different organs and from blood were harvested from each juvenile macaque. Gadolinium levels were measured by using inductively coupled plasma mass spectrometry. Results Gadolinium concentration in the amniotic fluid was 0.028 × 10-5 %ID/g (percentage injected dose per gram of tissue) 50 days after administration of one gadoteridol dose. Gadolinium was most consistently detected in the femur (mean, 2.5 × 10-5 %ID/g; range, [0.81-4.1] × 10-5 %ID/g) and liver (mean, 0.15 × 10-5 %ID/g; range, [0-0.26] × 10-5 %ID/g). Levels were undetectable in the remaining sampled tissues, with the exception of one juvenile skin sample (0.07 × 10-5 %ID/g), one juvenile spleen sample (0.039 × 10-5 %ID/g), and one juvenile brain (0.095 × 10-5 %ID/g) and kidney (0.13 × 10-5 %ID/g) sample. Conclusion The presence of gadoteridol in the amniotic fluid after maternal injection enables confirmation that it crosses the placenta. Extremely low levels of gadolinium are found in juvenile macaque tissues after in utero exposure to two doses of gadoteridol, indicating that a very small amount of gadolinium persists after delivery. © RSNA, 2017.
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Affiliation(s)
- Joao Prola-Netto
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Mark Woods
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Victoria H J Roberts
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Elinor L Sullivan
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Christina Ann Miller
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Antonio E Frias
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Karen Y Oh
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
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Budorick NE, Figueroa R, Vizcarra M, Shin J. Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta. J Matern Fetal Neonatal Med 2016; 30:2422-2427. [DOI: 10.1080/14767058.2016.1252744] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nancy E. Budorick
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA,
| | - Reinaldo Figueroa
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Quinnipiac University, Hartford, CT, USA,
| | - Michael Vizcarra
- Department of Obstetrics and Gynecology, Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA, USA, and
| | - James Shin
- Department of Radiology, Stony Brook University Health Sciences Center School of Medicine, Stony Brook, NY, USA
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Could Elastography Be Used in the Prediction of Morbidly Adherent Placentation? Case Rep Obstet Gynecol 2016; 2016:4909431. [PMID: 27965906 PMCID: PMC5124684 DOI: 10.1155/2016/4909431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022] Open
Abstract
Morbidly adherent placentation (MAP) is a condition in which the placenta is abnormally attached to the uterine myometrium. MAP is a complication of pregnancy that can cause significant morbidity to the mother and fetus and therefore early diagnosis is crucial in its management and prevention of adverse outcomes. Ultrasonography remains the primary diagnostic tool for MAP, with magnetic resonance imaging (MRI) serving as a secondary diagnostic modality. Elastography is a relatively new concept in ultrasound based imaging, which has found application in several fields of medicine, including obstetrics, primarily for evaluation of the firmness of cervical tissue in a preterm labour setting. We report a case on a patient who was diagnosed with placenta increta on ultrasound, aided by elastography and her subsequent management with an en bloc hysterectomy.
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When Timing Is Everything: Are Placental MRI Examinations Performed Before 24 Weeks' Gestational Age Reliable? AJR Am J Roentgenol 2015; 205:685-92. [DOI: 10.2214/ajr.14.14134] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Shetty MK, Dryden DK. Morbidly Adherent Placenta: Ultrasound Assessment and Supplemental Role of Magnetic Resonance Imaging. Semin Ultrasound CT MR 2015; 36:324-31. [DOI: 10.1053/j.sult.2015.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Oh KY, Roberts VHJ, Schabel MC, Grove KL, Woods M, Frias AE. Gadolinium Chelate Contrast Material in Pregnancy: Fetal Biodistribution in the Nonhuman Primate. Radiology 2015; 276:110-8. [PMID: 25763829 PMCID: PMC4485748 DOI: 10.1148/radiol.15141488] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine the extent to which gadolinium chelate is found in nonhuman primate fetal tissues and amniotic fluid at 19-45 hours after intravenous injection of a weight-appropriate maternal dose of the contrast agent gadoteridol. MATERIALS AND METHODS Gravid Japanese macaques (n = 14) were maintained as approved by the institutional animal care and utilization committee. In the 3rd trimester of pregnancy, the macaques were injected with gadoteridol (0.1 mmol per kilogram of maternal weight). Fetuses were delivered by means of cesarean section within 24 hours of maternal injection (range, 19-21 hours; n = 11) or 45 hours after injection (n = 3). Gadolinium chelate levels in the placenta, fetal tissues, and amniotic fluid were obtained by using inductively coupled plasma mass spectrometry. The Wilcoxon rank sum test was used for quantitative comparisons. RESULTS Gadoteridol was present in the fetoplacental circulation at much lower quantities than in the mother. At both time points, the distribution of gadolinium chelate in the fetus was comparable to that expected in an adult. The highest concentration of the injected dose (ID) was found in the fetal kidney (0.0161% ID per gram in the 19-21-hour group). The majority of the in utero gadolinium chelate was found in the amniotic fluid and the placenta (mean, 0.1361% ID per organ ± 0.076 [standard deviation] and 0.0939% ID per organ ± 0.0494, respectively). Data acquired 45 hours after injection showed a significant decrease in the gadolinium chelate concentration in amniotic fluid compared with that in the 19-21-hour group (from 0.0017% to 0.0007% ID per gram; P = .01). CONCLUSION Amounts of gadolinium chelate in the fetal tissues and amniotic fluid were minimal compared with the maternal ID. This may impact future clinical studies on the safety of gadolinium contrast agent use in pregnancy.
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Affiliation(s)
- Karen Y. Oh
- From the Department of Radiology (K.Y.O.), Advanced Imaging Research Center (M.C.S., M.W.), and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, MC L340, Portland, OR 97239; Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore (V.H.J.R., K.L.G., A.E.F.); and Department of Chemistry, Portland State University, Portland, Ore (M.W.)
| | - Victoria H. J. Roberts
- From the Department of Radiology (K.Y.O.), Advanced Imaging Research Center (M.C.S., M.W.), and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, MC L340, Portland, OR 97239; Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore (V.H.J.R., K.L.G., A.E.F.); and Department of Chemistry, Portland State University, Portland, Ore (M.W.)
| | - Matthias C. Schabel
- From the Department of Radiology (K.Y.O.), Advanced Imaging Research Center (M.C.S., M.W.), and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, MC L340, Portland, OR 97239; Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore (V.H.J.R., K.L.G., A.E.F.); and Department of Chemistry, Portland State University, Portland, Ore (M.W.)
| | - Kevin L. Grove
- From the Department of Radiology (K.Y.O.), Advanced Imaging Research Center (M.C.S., M.W.), and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, MC L340, Portland, OR 97239; Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore (V.H.J.R., K.L.G., A.E.F.); and Department of Chemistry, Portland State University, Portland, Ore (M.W.)
| | - Mark Woods
- From the Department of Radiology (K.Y.O.), Advanced Imaging Research Center (M.C.S., M.W.), and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, MC L340, Portland, OR 97239; Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore (V.H.J.R., K.L.G., A.E.F.); and Department of Chemistry, Portland State University, Portland, Ore (M.W.)
| | - Antonio E. Frias
- From the Department of Radiology (K.Y.O.), Advanced Imaging Research Center (M.C.S., M.W.), and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, MC L340, Portland, OR 97239; Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore (V.H.J.R., K.L.G., A.E.F.); and Department of Chemistry, Portland State University, Portland, Ore (M.W.)
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Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2015; 123:1070-1082. [PMID: 24785860 DOI: 10.1097/aog.0000000000000245] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
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Engelbrechtsen L, Langhoff-Roos J, Kjer JJ, Istre O. Placenta accreta: adherent placenta due to Asherman syndrome. Clin Case Rep 2015; 3:175-8. [PMID: 25838908 PMCID: PMC4377250 DOI: 10.1002/ccr3.194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/15/2014] [Accepted: 10/25/2014] [Indexed: 12/05/2022] Open
Abstract
It is important to be aware of the risk of abnormally invasive placenta in patients with a history of Asherman syndrome and uterine scarring. A prenatal diagnosis by ultrasonography is useful when planning of mode of delivery.
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Affiliation(s)
- Line Engelbrechtsen
- Department of Gynaecology, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Jens Joergen Kjer
- Department of Gynaecology, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Olav Istre
- Department of Obstetrics and Gynaecology, Odense University Hospital Odense, 5000, Denmark
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D'Antonio F, Iacovella C, Palacios-Jaraquemada J, Bruno CH, Manzoli L, Bhide A. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:8-16. [PMID: 24515654 DOI: 10.1002/uog.13327] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess systematically the performance of prenatal magnetic resonance imaging (MRI) in diagnosing the presence, degree and topography of disorders of invasive placentation and to explore the role of the different MRI signs in predicting these disorders. The diagnostic accuracy of ultrasound and MRI in the detection of invasive placentation was also compared. METHODS MEDLINE, EMBASE, CINAHL and The Cochrane Library, including The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and The Cochrane Central Register of Controlled Trials, were searched electronically utilizing combinations of the relevant medical subject heading terms, keywords and word variants for 'invasive placentation' and 'magnetic resonance imaging'. Only prospective studies reporting a diagnosis of invasive placentation at the time of MRI and retrospective studies in which the radiologist was blinded to the final results were included in the analysis. The MRI signs explored were: uterine bulging, heterogeneous signal intensity, dark intraplacental bands on T2 weighted sequences, focal interruption of the myometrium and tenting of the bladder. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-) and diagnostic odds ratio (DOR) were based, depending on the number of studies, upon DerSimonian-Laird random-effect or hierarchical summary receiver-operating characteristics models. RESULTS A total of 18 studies involving 1010 pregnancies at risk for invasive placentation were included. The overall diagnostic accuracy of MRI in detecting the presence of invasive placentation was: sensitivity, 94.4% (95% CI, 86.0-97.9%); specificity, 84.0% (95% CI, 76.0-89.8%); LR+, 5.91 (95% CI, 3.73-9.39); LR-, 0.07 (95% CI, 0.02-0.18); DOR, 89.0 (95% CI, 22.8-348.1). MRI had a high predictive accuracy in assessing both the depth and topography of placental invasion. All five MRI signs showed good predictive accuracy in the diagnosis of disorders of invasive placentation. There was no difference in either the sensitivity (P = 0.24) or the specificity (P = 0.91) between ultrasound and MRI for the detection of invasive placentation. CONCLUSIONS Prenatal MRI is highly accurate in diagnosing disorders of invasive placentation. Ultrasound and MRI have comparable predictive accuracy. Large population-based studies are needed in order to assess whether ultrasound can predict the depth and topography of placental invasion as reliably as can MRI.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: Executive summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol 2014; 210:387-97. [PMID: 24793721 DOI: 10.1016/j.ajog.2014.02.028] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/28/2022]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and magnetic resonance imaging in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost-effectiveness and to identify research opportunities. This article is the executive summary of the workshop.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX.
| | - Alfred Z Abuhamad
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
| | - Deborah Levine
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
| | - George R Saade
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
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Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:745-757. [PMID: 24764329 DOI: 10.7863/ultra.33.5.745] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 4B03F, Bethesda, MD 20892-7510 USA.
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Riteau AS, Tassin M, Chambon G, Le Vaillant C, de Laveaucoupet J, Quéré MP, Joubert M, Prevot S, Philippe HJ, Benachi A. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. PLoS One 2014; 9:e94866. [PMID: 24733409 PMCID: PMC3986371 DOI: 10.1371/journal.pone.0094866] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 03/20/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the accuracy of ultrasonography and magnetic resonance imaging (MRI) in the diagnosis of placenta accreta and to define the most relevant specific ultrasound and MRI features that may predict placental invasion. Material and Methods This study was approved by the institutional review board of the French College of Obstetricians and Gynecologists. We retrospectively reviewed the medical records of all patients referred for suspected placenta accreta to two university hospitals from 01/2001 to 05/2012. Our study population included 42 pregnant women who had been investigated by both ultrasonography and MRI. Ultrasound images and MRI were blindly reassessed for each case by 2 raters in order to score features that predict abnormal placental invasion. Results Sensitivity in the diagnosis of placenta accreta was 100% with ultrasound and 76.9% for MRI (P = 0.03). Specificity was 37.5% with ultrasonography and 50% for MRI (P = 0.6). The features of greatest sensitivity on ultrasonography were intraplacental lacunae and loss of the normal retroplacental clear space. Increased vascularization in the uterine serosa-bladder wall interface and vascularization perpendicular to the uterine wall had the best positive predictive value (92%). At MRI, uterine bulging had the best positive predictive value (85%) and its combination with the presence of dark intraplacental bands on T2-weighted images improved the predictive value to 90%. Conclusion Ultrasound imaging is the mainstay of screening for placenta accreta. MRI appears to be complementary to ultrasonography, especially when there are few ultrasound signs.
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Affiliation(s)
- Anne-Sophie Riteau
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, APHP, Clamart, France
- Department of Obstetrics and Gynecology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France
| | - Mikael Tassin
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, APHP, Clamart, France
| | - Guillemette Chambon
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, APHP, Clamart, France
| | - Claudine Le Vaillant
- Department of Obstetrics and Gynecology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France
| | | | - Marie-Pierre Quéré
- Department of Radiology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France
| | - Madeleine Joubert
- Department of Pathology, Hôpital Mère Enfant, Centre Hospitalier Universitaire Nantes, France
| | - Sophie Prevot
- Department of Pathology, Hôpital Antoine Béclère, APHP, Clamart, France
| | - Henri-Jean Philippe
- Department of Obstetrics and Gynecology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, APHP, Clamart, France
- * E-mail:
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Abstract
Morbidly adherent placenta, which describes placenta accreta, increta, and percreta, implies an abnormal implantation of the placenta into the uterine wall. The incidence of placenta accreta has increased significantly over the past several decades, with the main risk factors include prior cesarean section and placental previa. Sonographic markers of placenta accreta can be present as early as the first trimester and include a low uterine implantation of a gestational sac, multiple vascular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and abnormality of the uterine serosa-bladder interface, among others. Ultrasound has high sensitivity and specificity for the diagnosis of placenta accreta and MRI should be reserved for rare cases in which the ultrasound is non-diagnostic. The optimum time for planned delivery for a patient with placenta accreta is around 34-35 weeks following a course of corticosteroid injection. The successful management of placenta accreta includes a multidisciplinary care team approach with the successful management relying heavily on the prenatal diagnosis of this entity and preparing for the surgical management in a multidisciplinary approach by assuring the most skilled team is available for those patients.
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Affiliation(s)
- Alfred Abuhamad
- Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Hofheimer Hall, 825 Fairfax Ave, Suite 310, Norfolk, VA 23507.
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Berkley EM, Abuhamad AZ. Prenatal diagnosis of placenta accreta: is sonography all we need? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1345-1350. [PMID: 23887942 DOI: 10.7863/ultra.32.8.1345] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Eliza M Berkley
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507 USA.
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Lo TK, Yung WK, Lau WL, Law B, Lau S, Leung WC. Planned conservative management of placenta accreta - experience of a regional general hospital. J Matern Fetal Neonatal Med 2013; 27:291-6. [PMID: 23796273 DOI: 10.3109/14767058.2013.818118] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There are only a few series treating ≥10 cases of accreta conservatively, all from university teaching hospitals, with reported success rate of 60-85%. We reported the first series of accreta managed by planned uterine conservation in the setting of non-university district general hospital. METHODS Women with placenta previa overlying previous cesarean scar who desired uterine conservation were included. For cases with accreta confirmed during cesarean delivery, placenta was purposefully left behind, followed immediately by uterine artery embolization. Cases were followed in our special postnatal clinic. Charts were reviewed to retrieve clinical details. RESULTS Among 15 cases of placenta previa overlying cesarean scar opting for conservative management, 12 (80%) were confirmed to be accreta intra-operatively. They had 20-100% of the adherent placentae retained (median 90%) and their uterus preserved. Postpartum, abnormal vaginal bleeding and/or infection led to unscheduled readmission in 67% (8/12), all managed conservatively. Sonographic resolution of placenta took 2-13 months (median 6.6), and was later than menstrual return in 11 cases. CONCLUSIONS Successful planned conservative management of placenta accreta is feasible in the setting of district general hospital with facilities for interventional radiology.
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Affiliation(s)
- V V Wong
- Department of Obstetrics and Gynaecology, Limerick Regional Maternity Hospitals, Limerick, Republic of Ireland.
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Jauniaux E, Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta 2012; 33:244-51. [PMID: 22284667 DOI: 10.1016/j.placenta.2011.11.010] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 11/16/2011] [Accepted: 11/18/2011] [Indexed: 01/11/2023]
Abstract
Placenta accreta refers to different grades of abnormal placental attachment to the uterine wall, which are characterised by invasion of trophoblast into the myometrium. Placenta accreta has only been described and studied by pathologists for less than a century. The fact that the first detailed description of a placenta accreta happened within a couple of decades of major changes in the caesarean surgical techniques is highly suggestive of a direct relationship between prior uterine surgery and abnormal placenta adherence. Several concepts have been proposed to explain the abnormal placentation in placenta accreta including a primary defect of the trophoblast function, a secondary basalis defect due to a failure of normal decidualization and more recently an abnormal vascularisation and tissue oxygenation of the scar area. The vast majority of placenta accreta are found in women presenting with a previous history of caesarean section and a placenta praevia. Recent epidemiological studies have also found that the strongest risk factor for placenta praevia is a prior caesarean section suggesting that a failure of decidualization in the area of a previous uterine scar can have an impact on both implantation and placentation. Ultrasound studies of uterine caesarean section scar have shown that large and deep myometrial defects are often associated with absence of re-epithelialisation of the scar area. These findings support the concept of a primary deciduo-myometrium defect in placenta accreta, exposing the myometrium and its vasculature below the junctional zone to the migrating trophoblast. The loss of this normal plane of cleavage and the excessive vascular remodelling of the radial and arcuate arteries can explain the in-vivo findings and the clinical consequence of placenta accreta. Overall these data support the concept that abnormal decidualization and trophoblastic changes of the placental bed in placenta accreta are secondary to the uterine scar and thus entirely iatrogenic.
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Affiliation(s)
- E Jauniaux
- UCL Institute for Women's Health, University College London (UCL), London, UK.
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Mansour S, Elkhyat W. Placenta previa – accreta: Do we need MR imaging? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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